Failure to Progress

Definition

Failure to progress occurs when effective labor contractions do not lead to delivery of the baby. Failure to progress can be diagnosed in spite of medical interventions. The cervix may not dilate or efface. Effacement is a thinning of the cervix in preparation for delivery. Failure to progress can also happen if the baby does not move down the birth canal.

Causes

Some labors will stall without a clear cause. Uterine contractions can become ineffective, widely spaced, or both. This can happen despite the best efforts of a laboring woman and those who support her.

Risk Factors

Failure to progress may be more common in women over 35 years old. Other factors that increase your chance of failure to progress include:

Symptoms

In this phase, the following would be signs that labor was not progressing as expected:

Less than 3 contractions in 10 minutes, lasting less than 40 seconds each

Less than 1 centimeter change in cervical dilation per hour for two hours in a row
despite frequent and strong contractions

Once the cervix is fully dilated, pushing will begin. If a woman has an epidural, it can take up to 3 hours to deliver the baby if this is her first delivery. If it is not her first delivery, the baby usually comes out within 2 hours if she has an epidural. Times are shorter for women who do not have anesthesia.

Diagnosis

Failure to progress will not be diagnosed until after the active phase of labor has been achieved.

A monitor may be inserted into your uterus. The monitor is a small catheter with a device to measure the intensity of contractions. This will get more of an accurate record of the quality and strength of your contractions. The monitor can count how many there are, how long they last, how powerful they are, and how much time goes by between each one.

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Rupture of Membranes

Your water may be broken artificially using a tool made for that purpose.

Pain Medication

If you have not had any pain relieving drugs and you are in pain, your doctor may suggest that you consider pain treatment, such as an epidural. An epidural numbs the abdomen and legs.

Oxytocin

Oxytocin is a natural stimulant of the uterine muscle. It is used to improve the quality of contractions to help achieve adequate labor.

Delivery Options

If labor does not progress despite other efforts, or if the baby starts showing signs of distress, operative delivery will take place. In many cases this will mean having a cesarean delivery. Assisted vaginal delivery may be an option in situations where the baby is almost out of the birth canal during the pushing stage. A vacuum or forceps can be used to help the baby come out.

Prevention

There are no current guidelines to prevent failure to progress in labor.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.